Permission for Consent to Invite an Agency


Required Form
July - 2010
Ages 3-21

Teacher/School District:                                                                  


 ___________________________________________      ________________________     _____________________  
  Legal Name of Child/Student                                 Child/Student ID                          DOB

Permission for Consent Prior to Inviting Agencies Related to Transition


  Your permission is required to invite outside agencies to an IEP meeting that, if your child is eligible, may provide  
  or pay for transition services that may be essential or at the very least valuable to your child. Based on the
  student's needs the school has identified the following agencies which may be able to provide beneficial services
  pending your student qualifying for such services. These agencies will be invited at the appropriate time to either
  provide more information regarding their services or to begin the actual process of application/provision of 
  services. Please examine these agencies and indicate whether you either do or do not give consent for the
  school to invite the agency(s). Please refer to the local agency resource list (attached) which describes various
  community agencies and their services to indicate any other agency you think is appropriate to invite. It is
  important to not however that even if you permission is granted to provide an invitation to the identified 
  agencies below, the agency representative may not attend.

This permission shall be valid for the following duration. Beginning __________ and shall terminate ___________  
(Permission period should be not longer than current status to anticipated exit date)

  Please consider the following agencies the school has  
  identified as potentially important to your child's  
  transition and indicate whether you consent to have the   
  agency(s) invited to your child's IEP.  
         YES                        NO     

  Signature of Parent(s)                                                                                                    Date
  ___________________________________________________________                  ________________________________   

  Signature of Student (if student has reached the age of majority)                                  Date
  ___________________________________________________________                  ________________________________